Saturday, March 14, 2015

Last Sunday at Mass here in Plan
Grande I heard that a medical brigade was going to be at the Health Center
between Plan Grande and Concepcion on Thursday and Friday.I later saw a sign advertising the arrival of
“Medicos de Palmerola.”

I wondered if they would be a
medical team from the US base at Palmerola (now called Soto Cano). The history
of that base is another story – a sad reflection of US policy in Central
America in the 1980s where the US supported oppressive regimes in Guatemala, El
Salvador, and Honduras and supported the contras against the government of
Nicaragua. It’s a bloody page on US policy.

After thinking this over, I decided
to drop by on Thursday and see what was happening.

Sure enough, there were “gringo”
doctors and nurses and other military personnel – about 35 US military in all,
together with some Honduras civilian medical personnel and a number of Honduran
soldiers and military police.

There were some Spanish speakers
among the US soldiers, but most had only rudimentary Spanish. So there were
young people from a bilingual high school in Santa Rosa assisting them. I
decided to offer my translation services.

I ended up helping with the
distribution of vitamins after the groups received a talk on preventive
medicine. I mostly helped the young soldiers determine the ages of the children
as well as ask if the women were pregnant or not – especially since the brigade
was also giving deworming medication (which must not be given to pregnant or
nursing women).

I knew a lot of the people who came and
I tried to make clear to them that I was not giving out the medicine (since
they might want special attention from someone they knew). I also did my usual
kidding around with folks as well as trying to cover over my mistake of asking
a little overweight woman if she was pregnant. And, as a joke I asked a young
guy if he was pregnant; without batting an eye, he asked me the same question,
noting my gut.

I also asked a few young women if
they were pregnant. When they said no, I said, “That’s good. Don’t let the guys
take advantage of you.” They took it well, without showing any offense.

The presentation on preventive
medicine – germs, washing hands, good food preparation, and more - seemed to me
to have a few problems in relation to the people here.

The soldier talked about good
drinking water – using bleach, boiling, or buying bottled water. He noted the
importance of exercise for health. The presentation ended with him showing the
image of the healthy person — a male, who looked more life more a city person
than a campesino.

I mentioned a few of my concerns on the second day and the captain downplayed
the buying of bottled water. I also noted to him that there are few overweight
people in the countryside since they walk so much and work hard.

Thursday night I had decided to
write out my concerns and give it to him toward the end of the day. He was
grateful since he noted that he often asked people to evaluate what he was
saying but no one ever had.

In my note, I also shared a few
other concerns.

A few of the people come from communities that have no water system and so the people seek water wherever they can find it. Others have water systems but the source of the water has been contaminated. Water is a long-term community problem that needs community solutions, as well as individual preventative measures like boiling.

Also, what is the point in giving out
vitamins without serious explanation of what are the nutritional needs of
people and how to meet them? This, of course, is a long-term issue, especially
in light of the poverty diets of most people here that consist almost entirely
of corn tortillas and beans – with few vegetables.

I was also concerned about the
seemingly indiscriminate distribution of de-worming medicine. Of course it was
not given to pregnant or nursing mothers. But on Thursday a woman mentioned
that her son had gotten de-worming medicine earlier this week at the very
clinic where the brigade was. So I began to wonder if there were more kids who
were getting double doses of de-worming medication.Is that dangerous? Or is it just a poor use
of resources? I mentioned this on Friday morning and the captain doing the talk
told people that if they had recently been de-wormed they should not get the
medicine again.

I’m glad that I could share my
concerns and that someone listened with respect. That is not always the case.

But still I have my concerns about
these and other medical brigades.

There were probably over 600 people
who went through the talk on preventive medicine and then went to a
consultation with a medical doctor or to the dental clinic where they were
extracting teeth. My guess is that several hundred got teeth pulled.

The problem is that there is no
consistent ongoing medical and dental care for the people. Yes there are
government health centers in the municipal centers and in some rural areas. But
they are often poorly equipped and have minimal personnel.

The Honduran government is supposed
to provide medicine to the clinics several times a year – but most clinics have
almost no medicine and are lucky to get government medicine shipments once a
year or less. The Candelaria clinic’s two nurses are paid by the municipal
government. That is good. Where there are only nationally-funded staff, they
often are several months behind in wages.

The public health system is severely
broken here – and something needs to be done. The medical infrastructure, with
Honduran employees and oversight, needs to be built up so that consistent on-gong
care can be made available for the poor.

Another concern I have is that some
brigades come in and do not involve local medical personnel or do not know the
on-the-ground situation.

This raises a number of problems.
First of all, if local medical personnel is not involved or is involved only
peripherally this might give the people the idea that local doctors and nurse
aren’t good and that the foreigners are the ones who come in and heal them.

That is unfortunate and can lead to
serious problems – especially if areas get dependent on foreigners coming.

Another problem is the lack of
coordination, duplication of services, and perhaps some serious medical
problems. There were some efforts to this and the local director of the health
ministry was present both days.

Still there seem to be problems. I
think of the case mentioned above of children and others who had just received
deworming medicine and were being offered another dose. Fortunately, that was
dealt with on the second day.

But on Thursday one pregnant woman
told me that she had already received a month of pre-natal vitamins. That isn’t
a problem but may be a duplication of services. In my note to the military
person I noted that there are several pre-natal and neo-natal programs in the
area, including one financed by US AID.

I also have some concern about the
possible politicization of aid – especially by local politicians and political
parties, but that is for another post. I think this was largely avoided in this
case – though the mayor was there the first day, especially when the head of
the US troops arrived in a helicopter. Yet I do think the mayor is really
interested in the well-being of the people and is trying to improve their lives
– through education, health, and infrastructure.

There is another major concern I
have, which I won’t address here, is how these type of activities have created
a sense of dependency on outsiders and government officials and have minimized
the importance of personal initiative and community organization. That’s
another set of blog post.

But my final concern is the
militarization of health and other services.

I know this is coming from my
reading about or seeing the use of military in medical and other aid projects
during the wars in Viet Nam and El Salvador as attempts to “win the hearts and
minds of the people.” These were often overt ways of using aid for propaganda
purposes in situations of war and civil strife that were meant to provide
support for oppressive regimes.

I don’t equate Honduras with wartime
Viet Nam or El Salvador, but the question needs to be addressed.

But why is that the military has
access to medical supplies and personnel that are not available to civilians?

Also, could these efforts be ways of
promoting the militarization of society? In the midst of a great national
debate here in Honduras about the use of military in police functions and even
the creation of a Military Police Force, what is the message the people are
getting with these campaigns?

One military person personal asked
me of my opinion on the military in Honduras. He may have been talking about
the US military presence in Honduras (which I oppose) but I spoke more about
the militarization of society and the seeking of military solutions to problems
that need other major structural solutions, especially a judicial and police
system that responds to crimes. I referred him to The Locust Effect by Gary A.
Haugen and Victor Boutros, a book which has helped me understand and analyze
the problem of violence here.

What I really appreciated was the
opportunity to talk about a difficult subject with someone who is in the
military and the respect he gave me, though he may have disagreed with me.

Finally, I must say that it was good
that the people in the zone had an opportunity for some medical attention. They
really want and need that. One young woman told me that she had walked three
hours to get there. Others had taken a bus. And the kids from Plan Grande had
walked 30 minutes to get there. They had a talk about dental hygiene and, I think, got tooth brushes. They also listened to the preventive medicine talk which the captain revised for his audience.

I do not deny that there are serious medical needs. But how should they be addressed?

A few months ago, a dentist and I wrote up a proposal
for a local clinic or the poor and presented it to a US group financing a
clinic near La Entrada – about an hour north of here. She knew them from the clinic there and from a visit to the US she made last year. We have to revisit this proposal soon and see what can be done.

3 comments:

Thank you for your commentary and for your good work there Padre Juan. All that you write sounds so identical to the issues we faced in Lempira in the 1980s, except that in those days Palmerola was full of US troops and there were 11, I believe, airfields in the country capable of landing large transport planes. Randall Mullins, Memphis TN

An interesting account of a medical brigade - thanks for sharing. Prior to doing my PhD (for which your input was most valuable!) I was a nurse and a volunteer, and it was my experience with medical volunteering that directly led to my current academic journey. Although I haven't looked in any depth at brigades led by the military, your concerns echo many of those I raised in my Master's thesis, which can be read here, and in a paper I had published last year (I can send you a non-pay-walled version if you are interested). It is especially good that you were able to share your concerns and have them listened to, that is encouraging.

About Me

I am a permanent deacon in the diocese of Santa Rosa de Copán, ordained July 15, 2016. I help in the rural parish of Dulce Nombre de María. From June 2007 to that date I was a lay volunteer with the Catholic diocese of Santa Rosa de Copán, Honduras. Between 2009 and 2014 I served as associate director of Caritas of the diocese.
Soy un diácono permanente en the diócesis de Santa Rosa de Copán, Honduras, ordenado el 15 de julio de 2016.
The name "Hermano Juancito" - Brother little John or Brother Jack - was given to me by the children in the Suchitoto, El Salvador, countryside in 1992, a "title" which I treasure - worth more than any doctorate.